Political taboos, campaign dealbreakersand electoralglassceilings are crumbling. Members of Congress are openly gay and bisexual, there’s a black man in the White House, and a woman may be next. Voters have accepted all sorts of behavioral warts and missteps in their political candidates, too. DUIs? A mistake of their youth. Draft dodgers? There’s a long list. Womanizers? A much longer list. Illegal drugs? In just a few short elections, we’ve gone from a president who “didn’t inhale” to one who openly admits using cocaine in his youth.

Yet one large taboo remains stubbornly fixed—mental illness. Sure, it’s part of the conversation, in that pundits these days can, and do, speculate casually about whether Donald Trump has narcissistic personality disorder, Joe Biden has slid into depression, Hillary Clinton is clinically paranoid or Jeb Bush will be undone by a Freudian sibling tangle. But here’s the really sick thing: For a politician to admit to seeing a psychiatrist would likely be far more politically damaging than any of the possible symptoms of actual mental illness.

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For a president or a candidate, it’s the “kiss of death,” says Burton Lee, George H.W. Bush’s presidential physician. It would “create a crisis of confidence” in the country, says David Axelrod, former senior adviser to President Barack Obama. “I’d like to believe I’m wrong,” he adds, but a commander in chief who disclosed a mental illness would face an almost insurmountable political problem: “Every time he said a cross word or expressed frustration, people would say, ‘He’s having one of those days.’” Instead, Axelrod wryly notes, “We just watch their hair turn gray.”

More than 40 years have passed since Thomas Eagleton, the 1972 Democratic vice presidential candidate, withdrew from the race after revealing that he had been hospitalized for depression. Since that political firestorm, the issue has remained firmly off-limits: No Democratic or Republican nominee running for president or vice president has disclosed mental illness or treatment for it ever since—to do so would be politically incurable. And as recently as the last election cycle, congressional and state-level campaigns were digging up past psychiatric treatment to bludgeon their opponents.

“Any vulnerability can be exploited by people and will be,” explains Newt Gingrich, the former speaker of the House and presidential candidate, whose late mother had bipolar disorder. “That’s just the nature of a very rough-and-tumble-type business.”

As a result, the notion of politicians merely consulting with a mental health professional remains the topic of only hushed conversations or forceful denials. When President Bill Clinton admitted to infidelity and impeachment loomed, talking to a psychiatrist remained a political nonstarter. Aides told reporters that Clinton was seeking the counsel of Christian ministers but was “not under any medical treatment for any psychiatric or mental condition.” Even two decades later, “crazy” remains a politically acceptable epithet, whether it’s Obama taunting Republican opponents or Representative Trey Gowdy quipping that he did not want to wrangle members of the House in a leadership position because he did not “have a background in mental health.”

Yet, a review of the historical record finds that past commanders in chief, even well-regarded ones, struggled with mental health problems throughout their presidencies. “It’s a cliché that you have to be nuts to run for president,” says Evan Thomas, the journalist and historian whose latest book is an intimate biography of President Richard Nixon. “Like most clichés, it’s at least partly true.”

America's leading mental health practitioners ask the question: are you nuts to run for president?

Nixon and John F. Kennedy clandestinely filled their medicine cabinets with psychotropic drugs, recently uncovered documents reveal. In fact, Kennedy aide and historian Arthur Schlesinger Jr. suggested in his journals that several modern presidents were mentally unbalanced; he recorded top aides arguing whether President Lyndon Johnson was clinically paranoid or a manic-depressive, and fretted that there was no constitutional “procedure for dealing with nuts.”

In other words, mental illness is surely more common in Washington than the public knows or wants to believe. In 2006, after an embarrassing car accident, Representative Patrick Kennedy, JFK’s nephew, became a rare politician to announce he would seek treatment for his addiction and bipolar disorder. Soon, Kennedy says, several congressional colleagues privately revealed their own illnesses to him—but would not make them public. After interviewing more than three dozen people for this article, I found only one current member of Congress who has been open while in office about struggling with mental health: freshman Arizona Representative Ruben Gallego, an Iraq War veteran who suffers from post-traumatic stress disorder.

When it comes to their mental health, however, politicians, including the one with the nuclear launch codes, are “just like everybody else,” Lee says. Some diagnoses are dangerous, but others are manageable with treatment. For instance, he says, “A president can function very well if he has a mild anxiety disorder or obsessive compulsive [disorder].”

Which raises the question: When roughly a fifth of American adults use medication and millions go to talk therapy for their mental health, why shouldn’t the people governing the country be able to as well?

It would be hard for any public figure afflicted by the most severe mental illnesses—with symptoms like psychosis, hallucination and catatonic behavior—to evade notice or fully carry out his or her duties. But most people in psychiatric care do not have such debilitating disorders. Still, American politicians have historically grappled with milder symptoms—powerful mood swings, depression and anxiety—while serving in office, including the White House. Those afflictions can be exacerbated by the job. While scientists are still trying to understand the underlying medical causes of most mental illnesses, they are at least partly environmental; high stress can cause completely rational feelings of grief, concern and disappointment to become something more unstable. In the White House, Axelrod says, “The pressures are beyond anything that human beings are designed to handle.”

During the 1960 race, an aide misplaced Kennedy’s medication. “Find that bag,” he instructed. In the hands of his opponents, he said, “it would be murder.”

Yet the presence of such ailments, particularly at the highest levels of government, remains little known and little discussed. Asked whether Obama has ever consulted a psychiatrist, a White House official declined to discuss the president’s medical care. While the White House occasionally releases summaries of the president’s health, presidents and their doctors have lied and obfuscated in the past. Even after a president leaves office, medical records are considered private, not public record. As a result, the little we know about presidents’ mental health comes from sporadic glimpses at diaries or health records released only under rare circumstances.

Abraham Lincoln was famously melancholy, experiencing periods of such deep depression throughout his lifetime that he contemplated suicide and spent weeks at a time bedridden. The future president even tried the 19th-century version of an antidepressant: “blue mass” pills that, unfortunately for Lincoln, were a poisonous combination of ground mercury, rosewater and honey. (“The opposition researchers of today would have been very eager to discover Lincoln’s propensity for depression,” says presidential historian Michael Beschloss. “If they had, we might have lost perhaps our greatest president.”)